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  • Relationship between cannabis use frequency and major depressive disorder in adolescents: findings from the National Survey on Drug Use and Health 2012-2017
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-16
    Natalie Gukasyan; Eric C. Strain

    Background Cannabis use and major depressive disorder (MDD) are common and often co-morbid in adolescents, but the nature and directionality of the relationship between these two conditions remains obscure. Methods We examined results from the National Survey on Drug Use and Health. Weighted demographics were compared between adolescents with a history of cannabis use (N = 14,873) and never users (N = 73,079). Weighted logistic regression controlling for demographic variables and other substance use was used to determine the relationship between cannabis use frequency and MDD. Results Adolescents with any history of cannabis use had significantly higher rates of lifetime and past year MDD, MDD with severe role impairment, and past year suicide attempt (p < 0.001). Comparing use frequency groups in the adjusted model revealed that heavy users (weekly or greater use) had significantly lower predicted prevalence of lifetime and past year MDD, and past year MDD with severe role impairment compared to light users and those who used cannabis >1 year ago. Rates of reported past year suicide attempt did not differ significantly by cannabis use frequency. Conclusions Adolescents with any cannabis use history have significantly higher rates of MDD. However, the directionality between frequency of use and MDD is counter to what was expected.

    更新日期:2020-01-16
  • Is E-cigarette Use a Gateway to Marijuana Use? Longitudinal Examinations of Initiation, Reinitiation, and Persistence of E-Cigarette and Marijuana Use
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-15
    Su-Wei Wong; David K. Lohrmann; Susan E. Middlestadt; Hsien-Chang Lin

    Background Concerns have been raised regarding e-cigarette use as a potential stepping-stone to marijuana use. Based on Kandel’s gateway hypothesis, this study investigated if e-cigarette use could lead to marijuana use by testing two hypotheses with a longitudinal national U.S. adult sample, including (1) primary hypothesis: e-cigarette use is a gateway to marijuana use; and (2) falsification hypothesis: marijuana use isnot a gateway to e-cigarette use. Methods Adults were extracted from the Population Assessment of Tobacco and Health Study Waves 1-3 (2013-2016). For primary hypotheses, based on baseline e-cigarette use statuses, three study groups were defined, and three logistic regressions were conducted to examine associations between baseline e-cigarette use and follow-up marijuana use initiation, reinitiation, and persistence, respectively. Similarly, for falsification hypotheses, three additional study groups were defined, and three logistic regressions were conducted to examine associations between baseline marijuana use and follow-up e-cigarette use behaviors. Results Baseline e-cigarette use was associated with marijuana use initiation and reinitiation (ORs = 2.08, 1.37, respectively, both ps<.05) but not persistence at follow-up. Additionally, baseline marijuana use was associated with only e-cigarette use initiation (OR = 2.23, p < .01) but not reinitiation or persistence at follow-up. Conclusions Findings partially support the gateway hypothesis that e-cigarette use could be a steppingstone to marijuana use reinitiation among the U.S. adults. The mechanisms and behavioral characteristics, such as etiological and psychosocial factors, that may pertain to the progression from e-cigarette use to reinitiation of other substance use should be further investigated to inform effective behavioral, educational, and policy interventions.

    更新日期:2020-01-15
  • Understanding Opioid Use Disorder (OUD) Using Tree-Based Classifiers
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-15
    Adway S. Wadekar

    Background Opioid Use Disorder (OUD), defined as a physical or psychological reliance on opioids, is a public health epidemic. Identifying adults likely to develop OUD can help public health officials in planning effective intervention strategies. The aim of this paper is to develop a machine learning approach to predict adults at risk for OUD and to identify interactions between various characteristics that increase this risk. Methods In this approach, a data set was curated using the responses from the 2016 edition of the National Survey on Drug Use and Health (NSDUH). Using this data set, tree-based classifiers (decision tree and random forest) were trained, while employing downsampling to handle class imbalance. Predictions from the tree-based classifiers were also compared to the results from a logistic regression model. The results from the three classifiers were then interpreted synergistically to highlight individual characteristics and their interplay that pose a risk for OUD. Results Random forest predicted adults at risk for OUD with remarkable accuracy, with the average area under the Receiver-Operating-Characteristics curve (AUC) over 0.89, even though the prevalence of OUD was only about 1%. It showed a slight improvement over logistic regression. Logistic regression identified statistically significant characteristics, while random forest ranked the predictors in order of their contribution to OUD prediction. Early initiation of marijuana (before 18 years) emerged as the dominant predictor. Decision trees revealed that early marijuana initiation especially increased the risk if individuals: (i) were between 18-34 years of age, or (ii) had incomes less than $49,000, or (iii) were of Hispanic and White heritage, or (iv) were on probation, or (v) lived in neighborhoods with easy access to drugs. Conclusions Machine learning can accurately predict adults at risk for OUD, and identify interactions among the factors that pronounce this risk. Curbing early initiation of marijuana may be an effective prevention strategy against opioid addiction, especially in high risk groups.

    更新日期:2020-01-15
  • Recreational cannabis use impairs driving performance in the absence of acute intoxication
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-14
    M. Kathryn Dahlgren; Kelly A. Sagar; Rosemary T. Smith; Ashley M. Lambros; Madeline K. Kuppe; Staci A. Gruber

    Background Across the nation, growing numbers of individuals are exploring the use of cannabis for medical or recreational purposes, and the proportion of cannabis-positive drivers involved in fatal crashes increased from 8 percent in 2013 to 17 percent in 2014, raising concerns about the impact of cannabis use on driving. Previous studies have demonstrated that cannabis use is associated with impaired driving performance, but thus far, research has primarily focused on the effects of acute intoxication. Methods The current study assessed the potential impact of cannabis use on driving performance using a customized driving simulator in non-intoxicated, heavy, recreational cannabis users and healthy controls (HCs) without a history of cannabis use. Results Overall, cannabis users demonstrated impaired driving relative to HC participants with increased accidents, speed, and lateral movement, and reduced rule-following. Interestingly, however, when cannabis users were divided into groups based on age of onset of regular cannabis use, significant driving impairment was detected and completely localized to those with early onset (onset before age 16) relative to the late onset group (onset ≥16 years old). Further, covariate analyses suggest that impulsivity had a significant impact on performance differences. Conclusions Chronic, heavy, recreational cannabis use was associated with worse driving performance in non-intoxicated drivers, and earlier onset of use was associated with greater impairment. These results may be related to other factors associated with early exposure such as increased impulsivity.

    更新日期:2020-01-15
  • In vivo effects of 3,4-methylenedioxymethamphetamine (MDMA) and its deuterated form in rodents: drug discrimination and thermoregulation
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-13
    Michael D. Berquist; Sebastian Leth-Petersen; Jesper Langgaard Kristensen; William E. Fantegrossi

    Background Recent clinical studies support the use of 3,4-methylenedioxymethamphetamine (MDMA) as an adjunct treatment for posttraumatic stress disorder (PTSD). Despite these promising findings, MDMA administration in controlled settings can increase blood pressure, heart rate, and body temperature. Previous studies indicate thatO-demethylated metabolites of MDMA contribute to its adverse effects. As such, limiting the conversion of MDMA to reactive metabolites may mitigate some of its adverse effects and potentially improve its safety profile for therapeutic use. Methods We compared the interoceptive and hyperthermic effects of a deuterium-substituted form of MDMA (d2-MDMA) to MDMA using rodent drug discrimination and biotelemetry procedures, respectively. Results Compared to MDMA, d2-MDMA produced full substitution for a 1.5 mg/kg MDMA training stimulus with equal potency and effectiveness in the drug discrimination experiment. In addition, d2-MDMA produced increases in body temperature that were shorter-lasting and of lower magnitude compared to equivalent doses of MDMA. Last, d2-MDMA and MDMA were equally effective in reversing the hypothermic effects of the selective 5-HT2A/2C antagonist ketanserin. Conclusion These findings indicate that deuterium substitution of hydrogen at the methylenedioxy ring moiety does not impact MDMA’s interoceptive effects, and compared to MDMA, d2-MDMA has less potential for producing hyperthermic effects and likely has similar pharmacodynamic properties. Given that d2-MDMA produces less adverse effects than MDMA, but retains similar desirable effects that are thought to relate to the effective treatment of PTSD, additional investigations into its effects on cardiovascular functioning and pharmacokinetic properties are warranted.

    更新日期:2020-01-13
  • Role of the treatment environment in the effects of aripiprazole on ethanol-induced behavioral sensitization and conditioned place preference in female mice
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-13
    Matheus Libarino-Santos; Ana Catherine Gomes de Santana Santos; Elisangela G. Cata-Preta; Thaísa Barros-Santos; Nina Rosa Nunes Brandão; Aurea Lorena Borges; Renan Santos-Baldaia; André W. Hollais; Marilia A. Baldaia; Laís F. Berro; Eduardo A.V. Marinho; Roberto Frussa-Filho; Alexandre J. Oliveira-Lima

    Background Evidence suggests that aripiprazole, a partial dopamine D2 and serotonin 5-HT1A receptor agonist and 5-HT2A receptor antagonist, show significant efficacy in reducing alcohol use. We have previously demonstrated that treatment with aripiprazole blocked the reinstatement of cocaine-induced behavioral sensitization in a context-dependent manner, suggesting that the treatment environment may modulate the therapeutic effects of aripiprazole. The present study aimed to evaluate the effects of treatment with aripiprazole on ethanol-induced behavioral sensitization and conditioned place preference in female mice, and the role of the treatment environment in those effects. Methods Adult female mice were either sensitized with ethanol injections in the open-field apparatus, or conditioned with ethanol in the conditioned place preference (CPP) apparatus. Animals were then treated with vehicle or 0.1 mg/kg aripiprazole paired to the test environment (open-field or CPP apparatus) or not (home-cage treatments) for 4 alternate days, and the subsequent expression of behavioral sensitization or CPP to ethanol was evaluated during or following an ethanol re-exposure, respectively. Results Repeated treatment with aripiprazole attenuated the expression of ethanol-induced behavioral sensitization regardless of the treatment environment. Treatment with aripiprazole was only effective at preventing the reinstatement of ethanol-induced CPP when paired with the ethanol-associated environment, but not when administered in the home-cage. Conclusions The present findings corroborate previous studies suggesting the effectiveness of aripiprazole for the treatment of alcohol use disorder. Our results also point to an important role of the treatment environment in the therapeutic effects of aripiprazole in rodent models of ethanol abuse.

    更新日期:2020-01-13
  • Childhood social context in relation to alcohol expectancy through early adolescence: A latent profile approach
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Wan-Ting Chen; Nadia Wang; Kuan-Chia Lin; Chieh-Yu Liu; Wei J. Chen; Chuan-Yu Chen

    Background The present study aims to (i) identify patterns in the changes of endorsed positive alcohol expectancies (AEs) through early adolescence and (ii) examine associated childhood social context predictors of such profiles. Methods We used three waves of longitudinal data from the Alcohol-Related Experiences among Children. The baseline sample comprised 928 6th graders from 17 elementary schools in northern Taiwan (response rate = 60%); subsequent follow-up was conducted at 7th and 8th grade (follow-up rate = 88%). Data concerning three domains of positive AEs (i.e., global positive transformation, enhancing social behaviors, and promoting relaxation), social context, and alcohol drinking were collected by self-administered questionnaires. Longitudinal latent profile and survey multinomial logistic regression analyses were used to evaluate the association estimates, stratified by childhood alcohol initiation. Results Three distinct profiles (decreasing, stable, and increasing) of positive AEs were identified for the alcohol-naïve children (n = 466); observing paternal drinking and watching TV more than two hours per day at baseline were strongly linked with the stable and increasing AE profiles (aOR = 1.96-4.80). For the alcohol-experienced children, four profiles (low decreasing, low increasing, high decreasing, and high increasing) emerged; observing maternal drinking was predictive for the high-increasing profile (aOR = 2.94). Regardless of childhood alcohol initiation, recent alcohol use appeared to be the strongest predictor for the increasing profiles of positive AEs. Conclusions Strategies addressing pro-alcohol social contexts that facilitate a prominent increase in positive AEs should be considered when devising preventive programs targeting underage drinking behaviors and problems.

    更新日期:2020-01-13
  • Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Sharon R. Sznitman; Tamar Shochat; Talya Greene

    Background A substantial proportion of people using cannabis report using it to improve sleep. Yet, little research exists on the associations between the timing of cannabis use and sleep. This study examines the time elapsed between cannabis use and sleep start time and its association with two of the main indicators of sleep continuity: (1) sleep onset latency (SOL) and (2) number of awakenings (NOA) throughout the night. Methods Each morning, for 7 consecutive days, daily cannabis users (n = 54) reported on the timing of previous night’s cannabis use and sleep indicators on their smartphones. Mixed effects models examined the relations of within- and between-subjects’ time elapsed between previous night cannabis use and sleep start time, with (1) SOL and (2) NOA. Results Within subjects, shorter time elapsed between cannabis use and sleep start time was associated with shorter SOL (β = 0.519, p = 0.010), but not NOA (β = -0.030, p = 0.535). Furthermore, between individuals, the time gap between the previous night cannabis use and sleep start time was not associated with SOL or NOA (p > 0.05). Conclusions It is possible that cannabis use proximal to bedtime is associated with shorted sleep onset latency but not continuous sleep. Cannabis users should be informed about both the potential sleep aid effects of cannabis and its limitations. Pending further evidence of the effects of cannabis on sleep, cannabis users experiencing sleep problems should be provided with evidence-based alternatives to improve sleep, e.g., pharmacological and behavioral treatments.

    更新日期:2020-01-13
  • Clinical benefits and risks of N-Methyl-D-aspartate receptor antagonists to treat severe opioid use disorder: a systematic review
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Dimy Fluyau; Neelambika Revadigar; Christopher G Pierre

    Background Demand for treatments for severe opioid use disorder is increasing worldwide. The current pharmacotherapy is mainly focused on opioid and adrenergic receptors. The N-Methyl-D-aspartate receptor (NMDAR) is among other receptors that can also be targeted to treat the disease. Findings from randomized controlled trials (RTCs) on NMDAR antagonists to treat severe opioid use disorder amply varied. This study aimed to evaluate the clinical benefits and assess the potential risks for adverse events or side effects of NMDAR antagonists that were investigated for the treatment of severe opioid use disorder. Methods Articles were searched in PubMed, Scopus, Google Scholar, Proquest. Cochrane Review Database, Medline Ovid, and EMBASE from their inception to March 2019. RTCs on NMDAR antagonists for the treatment of severe opioid use disorder were independently screened and assessed by two authors. The results were synthesized qualitatively. Results Nineteen RTCs of 1459 participants met the inclusion criteria. There is moderate evidence suggesting that ketamine, memantine, amantadine, and dextromethorphan may be able to manage opioid withdrawal symptoms. There is little evidence suggesting that memantine may be able to reduce methadone maintenance dose in participants on methadone, reduce opioid use, and reduce craving. Dropout is noticeable among dextromethorphan’s participants. Safety concerns are more likely associated with dextromethorphan and ketamine. Conclusions NMDAR antagonists have the potentiality to treat severe opioid use disorder. There is insufficient evidence to recommend them for the treatment of severe opioid use disorder due to several limitations inherent to the RCTs reviewed. Further exploration is needed.

    更新日期:2020-01-13
  • Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Sandra Chyderiotis; Tarik Benmarhnia; François Beck; Stanislas Spilka; Stéphane Legleye

    Introduction According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking. Methods Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach. Results Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95%CI [0.60 – 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95%CI [0.66 – 0.89]. Conclusions Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

    更新日期:2020-01-13
  • Acute stressors and clinical characteristics differentiate death by suicide, accident, or natural causes among illicit and prescription opiate users
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Alison J. Athey; Eleanor E. Beale; James C. Overholser; Craig A. Stockmeier; Courtney L. Bagge

    Background Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death. Methods Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables. Results Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse. Conclusions The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.

    更新日期:2020-01-13
  • The neural interface between negative emotion regulation and motivation for change in cocaine dependent individuals under treatment
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-11
    Oren Contreras-Rodríguez; Natalia Albein-Urios; Jose Miguel Martinez-Gonzalez; José Manuel Menchón; Carles Soriano-Mas; Antonio Verdejo-García

    Background Emotion regulation is important for cocaine addiction treatment success, particularly during early abstinence. In addition, the neural underpinnings of emotion processing overlap with those of motivation and goal-directed behavior. We examined if the neural underpinnings of emotion maintenance and its regulation correlate with cocaine treatment motivation. Methods Forty-five cocaine dependent individuals (CDIs) starting outpatient treatment in a public specialized addiction treatment clinic in Granada (Spain) underwent fMRI scans while performing a Reappraisal task, and completed the University of Rhode Island Change Assessment Scale (URICA), to measure treatment motivation. We conducted correlation analyses to examine the association between emotion maintenance and regulation related brain activation and URICA’s Readiness to Change scores. We also explored links between Emotional reports during the fMRI reappraisal task, duration of abstinence, and anxiety and depression symptoms. Results Readiness to Change scores were positively correlated with activations in the right dorsolateral prefrontal and right parietal cortices, the midbrain (p ≤ 0.001, cluster extents ≥109 voxels), and basolateral amygdala (PFWE-SVC<0.05), while negatively with emotion maintenance related activation in the same cortical areas and activations in the dorsomedial frontal cortex, the nucleus accumbens and the left fusiform gyrus. Emotional reactivity negatively correlated with right dorsolateral prefrontal cortex reappraisal related activation (r= -0.40, p = 0.007), and the Regulate score positively correlated with the left fusiform gyrus emotion maintenance related activation (r = 0.31, p = 0.04). Conclusions Emotional related activation in frontoparietal, accumbens, fusiform, amygdala and midbrain regions engaged during emotion regulation correlate with early treatment motivation in CDIs.

    更新日期:2020-01-13
  • Alcohol Demand Assessed Daily: Validity, Variability, and the Influence of Drinking-Related Consequences
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-09
    Jennifer E. Merrill; Elizabeth R. Aston

    Background Alcohol demand, typically assessed at the trait-level, via single administration, reflects individualized alcohol value. We examined correspondence between trait-level and a brief measure of daily alcohol demand, and whether demand changes day-to-day in response to recent drinking-related consequences. Understanding whether consequences influence demand fluctuations may provide insight into when demand can be reduced in the context of intervention. Methods Heavy drinking college students (n = 95, age 18-20, 52% female) completed a baseline 14-item alcohol purchase task (APT). Observed demand indices were: intensity (consumption at zero cost), Omax (maximum expenditure), and breakpoint (cost whereby consumption is suppressed to zero). Participants subsequently completed 28 daily reports including a 3-item APT (one item corresponding to each baseline index) and prior day drinking and consequences. Results Intraclass correlations revealed within-person variability (i.e., day-to-day change) across daily demand indices. In hierarchical linear models (HLM), each daily demand index was significantly predicted by its corresponding baseline full APT index, when all three baseline indices were entered, suggesting convergent validity of the daily measure. Lower day-level intensity was predicted by more prior day negative consequences, controlling for several day- and person-level variables in HLM. Recent positive consequences did not impact intensity, and daily Omax and breakpoint were not predicted by any tested day- or person-level variables. Conclusions APT indices collected daily map on well to traditional single-administration APT metrics and change in response to recent consequences. Intensity demonstrated greatest within-person variability, strongest association with its corresponding full APT index, and theoretically-consistent prediction by negative consequences of drinking.

    更新日期:2020-01-09
  • Characterization of diverted buprenorphine use among adults entering corrections-based drug treatment in Kentucky
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-09
    Kirsten E. Smith; Martha D. Tillson; Michele Staton; Erin M. Winston

    Background Illicit, medically unsupervised use of buprenorphine (i.e., “diverted use”) among vulnerable and underserved populations, such as corrections-involved adults, remains underexplored. Methods Survey data (2016-2017) collected as part of a clinical assessment of incarcerated adults entering corrections-based substance use treatment in Kentucky were analyzed. For years examined, 12,915 completed the survey. Removing cases for participants who did not reside in Kentucky for >6 months during the one-year pre-incarceration period (n = 908) resulted in a final sample size of 12,007. Results Over a quarter of the sample reported past-year diverted buprenorphine use prior to incarceration and 21.8% reported use during the 30-days prior to incarceration, using 6.5 months and 14.3 days on average, respectively. A greater proportion of participants who reported diverted buprenorphine use had previously been engaged with some substance use treatment (77.0%) and reported greater perceived need for treatment (79.4%) compared to those who did not report use. Use was more likely among participants who were younger, white, male, and who reported rural or Appalachian residence. Diverted buprenorphine users also evidenced extensive polydrug use and presented with greater substance use disorder severity. Non-medical prescription opioid, heroin, and diverted methadone use were associated with increased odds of diverted buprenorphine use while kratom was not. Diverted methadone use was associated with a 252.9% increased likelihood of diverted buprenorphine use. Conclusions Diverted buprenorphine use among participants in this sample was associated with concerning high-risk behaviors and may indicate barriers to accessing opioid agonist therapies for corrections-involved Kentucky residents, particularly those in rural, Appalachia.

    更新日期:2020-01-09
  • Smile Judgment in Substance Use Disorders and its Relationship to Interpersonal and Emotional Functioning: An Eye-Tracking Investigation
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-09
    Annalie Pelot; Mélanie Perron; Sarah Lewis; Annie Roy-Charland

    The current study explored the judgments individuals with Substance Use Disorders (SUDs) make regarding the authenticity of enjoyment smiles and masking smiles containing traces of negative emotions. Accuracy at identifying the masked negative emotions were also examined. Eye-movements were recorded to observe relationships between attentional processes and smile judgment. Additionally, the relationships between smile judgment, emotion dysregulation, and interpersonal problems were investigated. Twenty individuals with SUDs and 20 individuals matched on gender/age participated in the smile judgment task. Results indicated that individuals with SUDs were no different in their categorization of smiles. However, the results showed that individuals with SUDs were significantly more likely to report the presence of negative emotions in the expressions. They were also more often incorrect in their identification of the masked emotions. No link was observed between smile judgment and attentional processes. Emotional and interpersonal functioning were related more to the ability to distinguish smile authenticity than the ability to identify masked emotions.

    更新日期:2020-01-09
  • How much are we exposed to alcohol in electronic media? Development of the Alcoholic Beverage Identification Deep Learning Algorithm (ABIDLA)
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-09
    Emmanuel Kuntsche; Abraham Albert Bonela; Gabriel Caluzzi; Mia Miller; Zhen He

    Background Evidence demonstrates that seeing alcoholic beverages in electronic media increases alcohol initiation and frequent and excessive drinking, particularly among young people. To efficiently assess this exposure, the aim was to develop the Alcoholic Beverage Identification Deep Learning Algorithm (ABIDLA) to automatically identify beer, wine and champagne/sparkling wine from images. Methods Using a specifically developed software, three coders annotated 57,186 images downloaded from Google. Supplemented by 10,000 images from ImageNet, images were split randomly into training data (70%), validation data (10%) and testing data (20%). For retest reliability, a fourth coder re-annotated a random subset of 2,004 images. Algorithms were trained using two state-of-the-art convolutional neural networks, Resnet (with different depths) and Densenet-121. Results With a correct classification (accuracy) of 73.75% when using six beverage categories (beer glass, beer bottle, beer can, wine, champagne, and other images), 84.09% with three (beer, wine/champagne, others) and 85.22% with two (beer/wine/champagne, others), Densenet-121 slightly outperformed all Resnet models. The highest accuracy was obtained for wine (78.91%) followed by beer can (77.43%) and beer cup (73.56%). Interrater reliability was almost perfect between the coders and the expert (Kappa = .903) and substantial between Densenet-121 and the coders (Kappa = .681). Conclusions Free from any response or coding burden and with a relatively high accuracy, the ABIDLA offers the possibility to screen all kinds of electronic media for images of alcohol. Providing more comprehensive evidence on exposure to alcoholic beverages is important because exposure instigates alcohol initiation and frequent and excessive drinking.

    更新日期:2020-01-09
  • The Rapidly Changing US Illicit Drug Market and the Potential for an Improved Early Warning System: Evidence from Ohio Drug Crime Labs
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-07
    Daniel Rosenblum; Jay Unick; Daniel Ciccarone

    Background The US has seen a rapid increase in synthetic opioid-related overdose deaths. We investigate Ohio, a state with one of the highest overdose death rates in 2017 and substantial numbers of deaths related to fentanyl, carfentanil, and other fentanyl analogs, to provide detailed evidence about the relationship between changes in the illicit drug market and overdose deaths. Methods We investigate the illicit drug market using Ohio's Bureau of Criminal Investigation's (BCI) crime lab data from 2009 to 2018 that shows the content of drugs seized by law enforcement. We use Poisson regression analysis to estimate the relationship between monthly crime lab data and monthly unintentional drug overdose death data at the county level. Results During this time period there has been a rapid change in the composition of drugs analyzed by the BCI labs, with a rapid fall in heroin observations, simultaneous rise in synthetic opioids, and an increase in the number of different fentanyl analogs. We find that the increased presence of fentanyl, carfentanil, and other fentanyl analogs have a strong correlation with an increase in overdose deaths. The types of opioids most associated with deaths varies by the population size of the county. Conclusions Crime lab data has the potential to be used as an early warning system to alert persons who inject drugs, harm reduction services, first responders, and law enforcement about changes in the illicit opioid risk environment.

    更新日期:2020-01-07
  • Potential undercounting of overdose deaths caused by specific drugs in vital statistics data: An analysis of Florida
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2020-01-07
    Troy C. Quast

    Introduction Due largely to ambiguous or incomplete information provided on death certificates, the widely cited Multiple Cause of Death (MCOD) data reported by the U.S. Centers for Disease Control and Prevention has been shown to undercount the number of fatal overdoses caused by specific drugs. However, the extent of the undercounts is unclear. Methods We obtained the number of fatal overdoses from 2003 to 2017 in Florida caused by the three drug groups (amphetamines, benzodiazepines, and opioids) and three drugs (methadone, cocaine, and heroin) that we could map across the MCOD data and data reported by the Florida Medical Examiners Commission (FMEC). The FMEC data are based on state-mandated reporting of the causal drugs in overdose deaths. We analyzed the differences across all deaths and by gender, age group, and race. Results Depending on the drug, the numbers of deaths across all individuals reported in the FMEC data ranged from 19 %–39 % higher than the counts in the MCOD data. The differences varied over time and by some demographic factors. Conclusions The MCOD data appear to undercount the number of fatal overdoses caused by the drugs we investigated. Our analysis did not identify a cause or pattern to explain the differences. Efforts to improve the reporting of fatal overdoses may enhance our understanding of and subsequently may improve the response to the drug overdose epidemic.

    更新日期:2020-01-07
  • Acute Alcohol Intake Alters Resting State Functional Connectivity of Nucleus Accumbens with Pain-related Corticolimbic Structures
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-24
    Jeff Boissoneault; Bethany Stennett; Michael E. Robinson

    Background The nucleus accumbens (NAc) is a ventral striatal structure underlying reward, reinforcement, and motivation, with extensive anatomic and functional connections to a wide range of affective processing structures (medial prefrontal cortex (mPFC), amygdala, and insula). Characterizing how acute alcohol intake affects resting state functional connectivity (rsFC) between the nucleus accumbens (NAc) and these regions will improve mechanistic understanding of alcohol’s neurobehavioral effects, including the neural overlap between acute alcohol effects and pain processing. Methods Fifteen healthy social drinkers (10 women; age: 25-45 years) were included in the study. Participants completed one session in which they consumed an alcohol dose targeting a breath alcohol concentration of 0.08 g/dL, and in a second a placebo beverage. Nine-minute resting state fMRI scans were acquired 30-35 minutes after beverage administration during each session. rsFC between NAc and a priori corticolimbic regions of interest (mPFC, amgydala, and insula), were compared between beverage conditions. We also conducted an exploratory whole-brain seed-to-voxel analysis of NAc FC. Results Alcohol intake reduced rsFC between NAc and mPFC, as well as NAc and amygdala. Alcohol also reduced rsFC between NAc and a 97-voxel cluster including bilateral paracingulate cortex and anterior cingulate cortex. Conclusions Findings suggest that acute alcohol intake reduces rsFC between NAc and several structures, including mPFC, amygdala, and rostral ACC in healthy social drinkers. These structures underlie reward, motivated behavior, and emotion regulation, and may provide mechanistic insight to how alcohol affects related processes, including pain.

    更新日期:2019-12-25
  • Methamphetamine use and violence: findings from a longitudinal birth cohort
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    James A. Foulds; Joseph M. Boden; Rebecca McKetin; Giles Newton-Howes

    Aims Evidence linking illicit methamphetamine use to violence perpetration and victimisation comes primarily from cross-sectional studies. These associations have not previously been studied in a longitudinal general population sample. Design Longitudinal birth cohort. Setting and participants General population sample (n = 1265) born in Christchurch, New Zealand in 1977. Measurements Participants were asked at age 21, 25, 30 and 35 about their frequency of methamphetamine use, and violence perpetration or victimization since the last interview. Violence was measured both in general, and within intimate partner relationships in particular. Logistic generalised estimating equations modelled the association between methamphetamine exposure and violence outcomes within each age period, adjusting for confounding factors and time-dynamic covariate factors. The dose-response profiles were explored via associations between heaviest methamphetamine use frequency from age 18-35 and violence outcomes in that period. Findings 28% of participants reported using methamphetamine at least once between age 18 and 35. Compared to no use, a history of any methamphetamine use in each age period was associated with an increased adjusted risk of violence perpetration (OR 1.60; 1.01-2.54), intimate partner violence perpetration (OR 1.55, 95% CI 1.04-2.30), and violence victimization (OR 1.57, 1.00-2.47). Evidence for an association with intimate partner violence victimization was inconclusive (OR 1.09, 0.80-1.49). There was a dose response relationship whereby those who had used methamphetamine at least weekly at any time from age 18-35 had substantially elevated adjusted odds of violence involvement compared to people who used but less often, or had never used. Conclusions Methamphetamine use is an independent risk factor for violence perpetration and victimisation in the general population.

    更新日期:2019-12-23
  • Quasi-experimentally examining the impact of introducing tobacco pictorial health warnings: Findings from the International Tobacco Control (ITC) 4C and Netherlands Surveys in the Netherlands, Australia, Canada, United Kingdom, and the United States
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Dirk-Jan A. van Mourik; Gera E. Nagelhout; Hein de Vries; Bas van den Putte; K. Michael Cummings; Ron Borland; Geoffrey T. Fong; Marc C. Willemsen

    Background Our study evaluated the short-term impact of introducing European Union’s tobacco pictorial health warnings (PHWs). Methods Longitudinal data were collected at two time-points from adult smokers, participating in the International Tobacco Control (ITC) surveys, conducted in the Netherlands, Australia, Canada, the United Kingdom and the United States. In the Netherlands, textual health warnings (THWs) were replaced by PHWs between both time-points. Health warning policies did not change in the other countries. Data from continuing smokers were used (N = 3,487) and analyzed using Generalized Estimating Equations. Results Between both time-points, only Dutch smokers showed increases in noticing health warnings (β = 0.712, p < 0.001), self-reports of health warnings leading to a cognitive response such as thinking about smoking health-risks (SHRs) (OR = 1.834, p < 0.001), knowledge about SHRs (β = 0.369, p < 0.001), and avoiding health warnings (OR = 9.869, p < 0.001). However, Dutch smokers showed no changes in attitude towards smoking (β = 0.035, p = 0.518), intention to quit smoking (OR = 0.791, p = 0.157), self-efficacy to quit smoking (β=-0.072, p = 0.286), or reporting that health warnings helped them to resist having a cigarette (OR = 1.091, p = 0.714). Conclusions Results suggest that introducing the European PHWs was effective in provoking changes closely related to health warnings, but there was no direct impact on variables more closely related to smoking cessation.

    更新日期:2019-12-23
  • Sex Differences in Substance Use from Adolescence to Young Adulthood: Tests of Increases in Emergent Adulthood and Maturing Out in Later Young Adulthood
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Michael Windle

    Introduction This study evaluated sex differences in substance use changes across two transitions: from adolescence (age 17 yrs.) to emergent adulthood (age 23 yrs.), and maturing out from emergent to later young adulthood (ages 28 and 33 yrs.). Methods Four-wave longitudinal data (N = 1004) from adolescence to young adulthood were used and five substance outcomes were assessed (cigarette, alcohol, and marijuana use, heavy drinking episodes (HDEs), and alcohol problems). A longitudinal mixed model tested Sex x Time interactions to determine if sex moderated changes in substance outcomes. Results Findings supported both increases in substance outcomes from adolescence to emergent adulthood and decreases in substance outcomes from emergent adulthood to later young adulthood. Sex moderated these relationships, with males increasing their use of substances more than females across the transition from adolescence to emergent adulthood. Findings were partially robust across substance outcomes, although sex specificity was indicated for some substance outcomes (e.g., males’ greater acceleration than females for HDEs) for the adolescent to emergent adult interval (from ages 17 to 23 years) and sex differences in maturing out for some outcomes (e.g., females’ matured out earlier than males for cigarette and marijuana use). Conclusions These findings provide support for developmental changes associated with significant increases in substance use during the early twenties and decreases (maturing out) in the late twenties and early thirties. Sex moderated the strength of these relationships and these sex differences may be associated with changes in young adult social roles (e.g., marriage, parenting, and occupational roles).

    更新日期:2019-12-23
  • OUT-OF-STATE CANNABIS PURCHASES IN THE UNITED STATES
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Elle Wadsworth; David Hammond

    Background Cannabis legalization at the US state level may have implications for cross-border purchases and diversion of legal products. The current study examined the association between out-of-state purchases and 1) cannabis regulations; and 2) the length of time a state has had recreational retail sales. Methods Data come from US respondents who participated in Wave 1 of the International Cannabis Policy Study (ICPS), conducted in August-October 2018. Respondents were aged 16–65 years who had used cannabis in the past 12 months (n = 4,320). Respondents were recruited using the Nielsen Consumer Insights Global Panel. Binary logistic regression models examined likelihood of any out-of-state cannabis purchases in the prior year, including differences by cannabis regulations, and time since recreational cannabis retail sales began. Results Overall, 15.0% of US cannabis users had made any out-of-state cannabis purchases in the past 12 months. Respondents in states where recreational cannabis was legal were less likely to make any out-of-state purchases than respondents in states where only medical cannabis was legal (AOR = 0.45, 95% CI: 0.34-0.60, p < 0.001) and where all cannabis was prohibited (AOR = 0.36, 95% CI: 0.26-0.50, p < 0.001). Among respondents in ‘legal’ states, a longer history of legal sales was associated with a lower likelihood of out-of-state cannabis purchases (AOR = 0.82, 95% CI: 0.72-0.93, p = 0.002). Conclusion The findings demonstrate that consumers in states where recreational cannabis is legal were less likely to purchase cannabis out-of-state than consumers in states where recreational cannabis is not legal. Future research should examine which states people travel to purchase cannabis and why.

    更新日期:2019-12-23
  • Sex Differences in Incidence and Psychiatric Comorbidity for Alcohol Dependence in Patients with Panic Disorder
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Hu-Ming Chang; Chun-Hung Pan; Pao-Huan Chen; Yi-Lung Chen; Ming-Hong Tai; Sheng-Siang Su; Shang-Ying Tsai; Chiao-Chicy Chen; Chian-Jue Kuo

    Background Sex differences in the development of alcohol dependence (AD) among patients with panic disorder (PD) remain unexplored. The study investigated sex as an effect modifier in the incidence of AD among patients with PD. Method We included 9480 patients with PD from the Taiwan National Health Insurance Research Database. A total of 169 patients (89 men and 80 women) developed incident AD during the follow-up period. Standardized incidence ratios (SIRs) were used to represent the relative risks of incident AD compared with the general population. Based on a nested case–control study design, 10 controls were selected for each case. Medical utilization and psychiatric comorbidity before diagnosing AD were analyzed using conditional logistic regression. Results The SIR of incident AD was 3.36 for men and 6.29 for women. Women with PD and incident AD had more visits to the outpatient department than the controls did, whereas men exhibited no significant differences. Women with incident AD were more likely to comorbid with depressive disorder (adjusted risk ratio [aRR] = 2.94), personality disorder (aRR = 5.03), and sleep disorder (aRR = 1.72), whereas men with incident AD were more likely to comorbid with sleep disorder (aRR = 1.85) and other substance use disorders (aRR = 3.08). Conclusion Patients with PD have an additional risk of developing AD compared with the general population, and that risk is higher in women. Women and men exhibited dissimilar patterns of medical utilization and psychiatric comorbidity before developing AD. Sex differences should be taken into consideration when establishing preventive measures.

    更新日期:2019-12-23
  • The effect of methadone on the hypothalamic pituitary gonadal axis and sexual function: a systematic review
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Hayley A. Ortman; Jessica A. Siegel

    Background Opioid abuse is a public health crisis. As opioid misuse worsens, efforts are being made to increase access to medication-assisted treatments. Methadone is a medication-assisted treatment used to treat opioid dependence and chronic pain. While methadone is beneficial in the treatment of opiate abuse and chronic pain, side effects of the medication include hormonal and sexual function changes. The purpose of this report is to review the effects of methadone on the hypothalamic pituitary gonadal axis hormones and sexual functioning in males and females. Methods A search of PubMed was conducted using pre-defined criteria, resulting in the evaluation of 295 articles. A total of 72 articles, including 52 human studies and 20 animal studies, met the selection criteria and were reviewed. The included studies examined the effects of methadone on the hypothalamic pituitary gonadal axis and/or sexual function. Results Methadone-induced hormonal changes, disruptions in the hypothalamic pituitary gonadal axis, and sexual dysfunction were evident, although there was some variability in the results of the reviewed studies. Differences in methadone dose and length of exposure to treatment appears to influence the variability in the results. Much of the literature examines the effects of methadone in males, with very limited research examining the effects in females. Conclusions Despite its effectiveness for opiate abuse and chronic pain treatment, methadone has disruptive effects on the hypothalamic pituitary gonadal axis and sexual function. Further research is warranted to better define potential methadone-induced endocrine consequences and to further examine the effects of methadone in females.

    更新日期:2019-12-23
  • Trends in the sequence of first alcohol, cannabis and cigarette use in Australia, 2001-2016
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Michael Livingston; John Holmes; Melissa Oldham; Rakhi Vashishtha; Amy Pennay

    Background Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s. Methods Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001-2016. We used data from 18-21 year-olds (n = 6,849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation. Results The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62% of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41% in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period. Conclusions Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years.

    更新日期:2019-12-23
  • Greater Delay Discounting and Cannabis Coping Motives are Associated with More Frequent Cannabis Use in a Large Sample of Adult Cannabis Users
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Michael J. Sofis; Alan J. Budney; Catherine Stanger; Ashley A. Knapp; Jacob T. Borodovsky

    Background Self-regulation deficits expressed through a decreased ability to value future rewards (delay discounting (DD)) and impaired emotion regulation (negative urgency (NU), cannabis coping motives (CCM), and anxiety sensitivity (AS)) relate to more frequent or problematic cannabis use. However, there is a need to better understand how self-regulation and emotion regulation constructs reflect competition between deliberative and reactive systems that drive individual differences in cannabis use patterns. Further, few studies assess frequency of cannabis use within and across days of use, which may obscure differentiation of individual differences. Methods In a large national sample of 2,545 cannabis users, Latent Class Analysis was used to derive participant sub-classes based on two frequency indices, self-reported cannabis use days and times cannabis was used per day. Three classes emerged: Low (1-9 days/month, 1 time/day; 23%), moderate (10-29 days/month, 2-3 times/day; 41%), and high (30 days/month, ≥4 times/day; 36%). Relationships among frequency classes and emotional regulation and impulsivity were assessed with a multinomial logistic regression. Results Higher frequency use was associated with greater DD (χ2 = 6.0, p = .05), greater CCM (χ2 = 73.3, p < .001), and lower cognitive AS (χ2 = 12.1, p = .002), when controlling for demographics, tobacco use, and number of cannabis administration methods. Frequency class and NU were not significantly associated. Conclusions Identifying meaningful patterns of cannabis use may improve our understanding of individual differences that increase risk of frequent or problematic cannabis use. Excessive delay discounting and using cannabis to cope with negative affect may be relevant targets for treatments designed to reduce cannabis use.

    更新日期:2019-12-23
  • Variables associated with low, moderate and high emergency department use among patients with substance-related disorders
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Louise Penzenstadler; Lia Gentil; Christophe Huỳnh; Guy Grenier; Marie-Josée Fleury

    Aims This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15. Methods Participants (n = 4,731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables. Results Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge. Conclusions Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.

    更新日期:2019-12-23
  • Characterizing latent classes of social support among persons who inject drugs
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Paul L. Sacamano; Shruti H. Mehta; Carl Latkin; Oluwaseun Falade-Nwulia; Gregory D. Kirk; Abby E. Rudolph

    Background Social network members influence risk and health behaviors, yet little is known about the support that persons who inject drugs (PWID) receive from their closest ties. Methods 970 participants from the AIDS Linked to the IntraVenous Experience (ALIVE) study completed a social network survey between April 2016 and June 2017 about their five closest ties. Our analysis: 1) identified latent classes of support received by participants; 2) determined whether class membership differed by current (≤12 months) vs.former (>12 months) injection drug use; 3) compared classes of support by individual and network characteristics. Results 970 participants listed 3,388 network members. We identified three support classes: (1) Moderate (n = 249): probabilities of support <0.40; (2) High (n = 366): probabilities of support 0.58-0.82; (3) Very high (n = 355): probabilities of support 0.91-0.99. In adjusted analysis compared to moderate support, the odds of high and very high support increased as the mean age of network members increased (Adjusted Odds Ratio [AOR]:1.03; 95% CI: 1.01, 1.05) and as the number of network members with whom they interacted daily increased (AORhigh: 1.33; 95% CI:1.14, 1.56 and AORvery high: 1.54; 95% CI: 1.30, 1.83). While current injection drug use was associated with lower unadjusted odds of high and very high support, the associations were not statistically significant in adjusted analysis. Conclusions Support was higher among networks of older ties and more frequent interaction, but differences did not appear to be driven by injection drug use status. Findings point to the importance of the closest social ties.

    更新日期:2019-12-23
  • Validity of International Classification of Diseases codes in identifying illicit drug use target conditions using medical record data as a reference standard: A systematic review
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    Kaitlin McGrew; Juell Homco; Tabitha Garwe; Hanh Dung Dao; Mary B. Williams; Douglas A. Drevets; S. Reza Jafarzadeh; Yan Daniel Zhao; Hélène Carabin

    Background The twenty-first century opioid crisis has spurred interest in using International Classification of Diseases (ICD) code algorithms to identify patients using illicit drugs from administrative healthcare data. We conducted a systematic review of studies that validated ICD code algorithms for illicit drug use against a reference standard of medical record data. Methods Systematic searches of MEDLINE, EMBASE, PsycINFO, and Web of Science were conducted for studies published between 1980 and 2018 in English, French, Italian, or Spanish. We included validation studies of ICD-9 or ICD-10 code algorithms for an illicit drug use target condition (e.g., illicit drug use, abuse, or dependence (UAD), illicit drug use-related complications) given the sensitivity or specificity was reported or could be calculated. Bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies Version 2 (QUADAS-2) tool. Results Six of the 1,210 articles identified met the inclusion criteria. For validation studies of broad UAD (n = 4), the specificity was nearly perfect, but the sensitivity ranged from 47% to 83%, with higher sensitivities tending to occur in higher prevalence populations. For validation studies of injection drug use (IDU)-associated infective endocarditis (n = 2), sensitivity and specificity were poor due to the lack of an ICD code for IDU. For all six studies, the risk of bias for the QUADAS-2 “reference standard” and “flow/timing domains” was scored as “unclear” due to insufficient reporting. Conclusions Few studies have validated ICD code algorithms for illicit drug use target conditions, and available evidence is challenging to interpret due to inadequate reporting. PROSPERO Registration: CRD42019118401

    更新日期:2019-12-23
  • History of withdrawal modulates drug- and food-cue reactivity in cocaine dependent participants
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    William James Denomme; Matthew S. Shane

    While the centrality of withdrawal in the diagnosis of addiction has been decreasing with each successive edition of the Diagnostic and Statistical Manual of Mental Disorders, psychometric, neurobiological and neuroimaging evidence provides withdrawal a central role in the development and maintenance of addiction. The current study offers insight into these conflicting positions by using secondary analyses to assess how a history of DSM-assessed withdrawal influences the existence of bias in neural reactivity to drug- and food-related reward cues. To this end, we compared drug- and food-cue reactivity within a sample of cocaine-dependent participants with (WD) and without (N-WD) a history of withdrawal, and a non-dependent control group (ND), within which dependency-related cue-reactivity biases were previously noted (Denomme et al., 2018). Analyses indicated that craving-related biases in reactivity towards drug- versus food-related cues only occurred among the WD participants (within: left dorsomedial prefrontal cortex, left anterior cingulate cortex, left orbitofrontal cortex, left caudate nucleus, and right ventrolateral prefrontal cortex). We interpret this as indication that withdrawal serves as an important factor for understanding dependence-related biases in neural processing towards reward-related cues. Interestingly, while N-WD participants did not show these broad biases in neural reactivity, the strength of their bias correlated positively with years of lifetime substance use history, particularly when psychopathic traits were low. Thus, for individuals where addiction has not yet reached a compulsive state (see Wise and Koob, 2014), the strength of one’s drug > food bias may serve as a valuable biomarker of behavioral risk factors for addiction.

    更新日期:2019-12-23
  • The Relationship between Perceived Stress and Depression in Substance Use Disorder Treatment
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-23
    R. Kathryn McHugh; Dawn E. Sugarman; Laurel Meyer; Garrett M. Fitzmaurice; Shelly F. Greenfield

    Background Depression is highly prevalent among individuals with SUDs, especially women, and has been noted to improve during SUD treatment. Perceived stress is independently related to severity of depression and substance use disorders (SUD) as well as recurrence of symptoms and relapse following treatment. The aim of this study was to investigate among adults enrolled in SUD treatment whether levels of perceived stress and substance use over the course of treatment were related to reduction in depression. Methods This is a secondary analysis of data from the Women’s Recovery Group Study. Women (n = 100) were randomized to either single- or mixed-gender group therapy and men (n = 58) received mixed-gender group therapy. Measures of substance use, perceived stress and depressive symptoms were collected for 6 months following treatment completion. In this study, we used lagged mixed models to investigate whether levels of substance use and perceived stress at each time point were associated with changes in depression at the subsequent time point. Results Results indicated that depressive symptoms significantly improved over time. Both substance use and perceived stress were associated with subsequent depressive symptoms. Importantly, stress was associated with symptoms when controlling for substance use, suggesting that changes in depressive symptoms were not solely attributable to levels of substance use. Conclusions These results suggest that both stress and substance use are associated with improvements in depressive symptoms in substance use disorder treatment. Although preliminary, these results provide further support for the importance of targeting stress reduction in people with substance use disorders.

    更新日期:2019-12-23
  • Social marginalization, gender-based violence, and binge drinking among transgender women in Cambodia
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-14
    Siyan Yi; Navy Chann; Pheak Chhoun; Sovannary Tuot; Phalkun Mun; Carinne Brody

    Background Transgender women experience disproportionate social stigma that may lead to behavioral risks and poor psychological wellbeing. This study examines social and behavioral factors associated with binge drinking among transgender women in Cambodia. Methods A cross-sectional survey was conducted in 2016 among 1039 transgender women recruited from 13 provinces using the Respondent Driven Sampling method. A structured questionnaire was used for face-to-face interviews. Weighted multivariable logistic regression analysis was conducted to identify risk factors associated with binge drinking. Results The prevalence of binge drinking was 43.3 %. After adjustment, the odds of binge drinking were significantly higher among participants in the age group of 25–34 compared to those in the age group of 18–24 and lower among participants in job categories such as hairdresser or beautician, office workers, and self-employed compared to those who were unemployed. The odds of binge drinking were significantly higher in participants who dropped out of school and thought it was because of their transgender identity, had transactional sex in the past three months, used amphetamine-type stimulants in the past three months, and reported experience of verbal abuse by family members during childhood. Regarding mental health, the odds of binge drinking were significantly lower among participants who had depressive symptoms over the past week. Conclusions These findings highlight the intersections between social marginalization, gender-based violence, HIV risks, and alcohol abuse. We recommend further exploration of the structural factors that may be modifiable through workplace policies or occupational health interventions among transgender women.

    更新日期:2019-12-17
  • Changes in fentanyl demand following naltrexone, morphine, and buprenorphine in male rats
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Lindsey R. Hammerslag; Rebecca S. Hofford; Qiwen Kang; Richard J. Kryscio; Joshua S. Beckmann; Michael T. Bardo

    Background Individuals with opioid use disorder (OUD) exhibit high levels of economic demand for opioids, with high levels of consumption and relative insensitivity to changes in price. Because the medications used to treat OUD in medication-assisted therapy (MAT) act as antagonists or agonists at µ opioid receptors, they may alter the relationship between price and opioid intake. Methods This study examined demand for a commonly abused synthetic prescription opioid, fentanyl, in male rats following s.c. pre-treatment with naltrexone (0.1 - 1.0 mg/kg), morphine (0.3 - 3.0 mg/kg) or buprenorphine (0.3 - 3.0 mg/kg). We normalized demand curves to intake at the lowest price and estimated effects on elasticity (sensitivity to changes in price). Rats were first trained to earn fentanyl (5 µg/kg/infusion) on a fixed ratio schedule, then they underwent daily training under a threshold procedure designed to produce within-session demand curve estimates. Rats received 14 threshold sessions before undergoing a series of tests encompassing each drug, at each dose. Results Elasticity was increased by pretreatment with naltrexone, morphine or buprenorphine. Morphine also decreased initial intake, when the price for fentanyl was lowest. In contrast, initial intake was increased by naltrexone (according to an inverted-U shaped curve). The effects of naltrexone did not persist after the test session, but morphine and buprenorphine continued affecting demand intensity 24 h or 48 h after the test, respectively. Conclusions These results indicate that fentanyl demand is sensitive to blockade or activation of opioid receptors by the drug classes used for MAT in humans.

    更新日期:2019-12-17
  • Injection Drug Use, Unknown HIV Positive Status, and Self-reported Current PrEP Use Among Black Men Who Have Sex with Men Attending U.S. Black Pride Events, 2014-2017
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Jessica L. Maksut; Rachel E. Gicquelais; Kevon-Mark Jackman; Lisa A. Eaton; M. Revel Friedman; Derrick D. Matthews; Leigh A. Bukowski; Ron D. Stall
    更新日期:2019-12-17
  • Inhibitory-Control Training for Cocaine Use Disorder and Contingency Management for Clinic Attendance: A Randomized Pilot Study of Feasibility, Acceptability and Initial Efficacy
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Craig R. Rush; Justin C. Strickland; Erika Pike; Christina R. Studts; William W. Stoops

    Background Cocaine abusers have impaired inhibitory control. This study determined the feasibility, acceptability, and initial efficacy of inhibitory-control training to cocaine or neutral images in cocaine use disorder patients. Methods Participants were randomly assigned to inhibitory-control training to cocaine (N = 20) or neutral (N = 20) images. Feasibility was assessed by percent of patients eligible for participation after a behavioral qualification session, time-to-target enrollment, percent of clinic visits attended, percent of participants who completed 80% or more training sessions, and percent of follow-up visits attended. Acceptability was determined using a Treatment Acceptability Questionnaire. Initial efficacy was determined during training and a follow-up phase with urine samples tested qualitatively and quantitatively for cocaine. Participants in both conditions received monetary incentives delivered on an escalating schedule for clinic attendance. Results The groups were well matched and no differences on demographic or substance use variables were observed. Attendance was stable during the treatment period with high overall attendance in both groups (average sessions attended: cocaine images group = 97%; neutral image group = 90%). No group differences were observed in the percentage of follow-up sessions attended (95% for the cocaine-image group; 88% of neutral image group). Ratings on the Treatment Acceptability Questionnaire were high (i.e., mean scores ≥ 80 for all items rated on 101-unit visual analog scales). Participants in the cocaine- and neutral-image conditions did not differ significantly in terms of cocaine use during the training nor follow-up phase. Inhibitory-control training improved stop signal performance but not delay discounting. Conclusion The procedures were feasible and acceptable. Inhibitory-control training to cocaine images did not reduce cocaine use relative to the neutral image training condition. The inability to detect significant differences in cocaine use across the groups is not surprising given the small sample size. More research is needed to determine the utility of inhibitory-control training for cocaine use disorder. Future trials should determine whether inhibitory-control training to cocaine images augments the efficacy of other behavioral interventions.

    更新日期:2019-12-17
  • Regional trends in suspected synthetic cannabinoid exposure from January 2016 to September 2019 in the United States
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Douglas R. Roehler; Brooke E. Hoots; Alana M. Vivolo-Kantor

    Background The unpredictable physiologic and pharmacologic effects of synthetic cannabinoids (SCs) are continuously changing as the chemical structure of SCs evolve to avoid classification as a Schedule I drug under the Controlled Substances Act in the U.S. This results in unpredictable pharmacologic effects and subsequent sequelae. Little is known about national or regional trends of SC clusters. The objective of this study is to investigate trends in SC exposure using emergency department (ED) syndromic data. Methods We analyzed ED syndromic data to detect quarterly trends from January 2016 through September 2019 for SC-related exposures within 59 jurisdictions in 47 states by U.S. region. Pearson chi-square tests detected quarter-to-quarter changes and Joinpoint regression assessed trends over time. Results From January 2016 to September 2019, 21,714 of 303.5 million ED visits involved suspected SC exposures. Nationally, SC-related exposures decreased by 1.9% (p = .04) on average per quarter, yet exposures increased in the Midwest by 6.3% (p = .002) and in the Northeast by 3.2% (p = .03) on average per quarter, and decreased on average per quarter by 7.7% (p ≤ .001) in the Southeast and 11.4% in the West (p ≤ .001). Known SC exposures that may align with clusters were identified in quarter-to-quarter monitoring. Conclusions Only a small proportion of ED visits were related to suspected SC exposure. Although we did identify a small decrease in national SC exposures, there was wide variation by region. Additional efforts are needed to understand variation and to develop prevention and response strategies.

    更新日期:2019-12-17
  • Differential Responses to Infant Faces in Relation to Maternal Substance Use: An Exploratory Study
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Helena J.V. Rutherford; Sarah W. Yip; Patrick D. Worhunsky; Sohye Kim; Lane Strathearn; Marc N. Potenza; Linda C. Mayes

    Background Maternal substance use and addiction has been associated with negative consequences for parenting and may increase addiction vulnerability in the developing child. Neuroimaging research suggests that substance use may decrease the reward of caring for infants and heighten stress reactivity to affective infant cues. Methods Thirty-two substance-using mothers and twenty-two non-substance-using mothers were presented with emotional face and cry stimuli generated from their own and a demographically matched unknown infant during fMRI scanning. Between-group differences in neural activity during task performance were assessed using whole-brain, mixed-effects models corrected for multiple comparisons (voxel-level p < 0.001, pFWE<0.05). Results Relative to non-substance-using mothers, substance-using mothers exhibited greater activation when viewing their own infant’s face as compared to an unknown infant’s face across multiple brain regions, including superior medial frontal, inferior parietal, and middle temporal regions. Substance-using mothers also had a decreased response to sad infant faces in the ventral striatum relative to the non-substance-using mothers. Neural responses to own vs. unknown infant cries did not significantly differ between substance-using and non-substance-using mothers. Conclusions Findings suggest overlapping cortical and subcortical brain regions implicated in responding to infant faces, with activation differences related to infant familiarity, emotional expression, and maternal substance use. While prior work has focused on attenuated neural responses to infant cues, greater attention is needed toward understanding the increased reactivity to affective infant cues observed in substance-using mothers.

    更新日期:2019-12-17
  • Assessing the motivational effects of ethanol in mice using a discrete-trial current-intensity intracranial self-stimulation procedure
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-16
    Amanda M. Barkley-Levenson; Andre Der-Avakian; Abraham A. Palmer

    Background Alcohol (ethanol) produces both rewarding and aversive effects, and sensitivity to these effects is associated with risk for an alcohol use disorder (AUD). Measurement of these motivational effects in animal models is an important but challenging aspect of preclinical research into the neurobiology of AUD. Here, we evaluated whether a discrete-trial current-intensity intracranial self-stimulation (ICSS) procedure can be used to assess both reward-enhancing and aversive responses to ethanol in mice. Methods Male and female C57BL/6 J mice were surgically implanted with bipolar stimulating electrodes targeting the medial forebrain bundle and trained on a discrete-trial current-intensity ICSS procedure. Mice were tested for changes in response thresholds after various doses of ethanol (0.5 g/kg-1.75 g/kg; n = 5-7 per dose), using a Latin square design. Results A 1 g/kg dose of ethanol produced a significant reward-enhancement (i.e., lowered response thresholds), whereas a 1.75 g/kg dose produced an aversive effect (elevated response thresholds). Ethanol doses from 1-1.75 g/kg increased response latencies as compared to saline treatment. Conclusions The discrete-trial current-intensity ICSS procedure is an effective assay for measuring both reward-enhancing responses to ethanol as well as aversive responses in the same animal. This should prove to be a useful tool for assessing the effects of experimental manipulations on the motivational effects of ethanol in mice.

    更新日期:2019-12-17
  • A Randomized Clinical Trial of Motivational Interviewing Plus Skills Training vs. Relaxation Plus Education and 12-Steps for Substance Using Incarcerated Youth: Effects on Alcohol, Marijuana and Crimes of Aggression
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-13
    L.A.R. Stein; Rosemarie Martin; Mary Clair-Michaud; Rebecca Lebeau; Warren Hurlbut; Christopher W. Kahler; Peter M. Monti; Damaris Rohsenow

    Background Motivational Interviewing plus Cognitive Behavior Therapy (MI/CBT) has been used to reduce adolescent substance use, but has rarely been applied in youth correctional settings. This trial compared MI/CBT against Relaxation Training plus Substance-Education/12-Steps (RT/SET) to reduce substance use and crime among incarcerated youth. Methods Participants (N = 199) were incarcerated juveniles (64.8% non-White, 10.1% girls, mean age of 17.1 years). Two individual sessions of MI (or RT) were followed by 10 group sessions of CBT (or SET). Youth were randomized to condition with follow-ups at 3- and 6-months after release. Major outcomes included alcohol, marijuana and crimes involving aggression. Results A marginal treatment by time interaction was found for percent heavy drinking days, with follow-up tests indicating less alcohol use in RT/SET than MI/CBT at 6 months, and increased use within MI/CBT from 3 to 6 months. A significant treatment by time interaction was found for alcohol-related predatory aggression, with follow-up tests indicating fewer youth engaged in this behavior from 3 to 6 months within RT/SET, and weak evidence favoring MI/CBT over RT/SET at 3 months. General predatory aggression decreased from 3 to 6-months for both treatments. Conclusions Although weak evidence was found favoring MI/CBT with respect to alcohol-related predatory aggression, results generally support RT/SET in reducing percent heavy drinking days.

    更新日期:2019-12-17
  • Co-Use of Tobacco and Marijuana Among Young People Experiencing Homelessness in Los Angeles County
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-13
    Joan S. Tucker; William G. Shadel; Rachana Seelam; Daniela Golinelli; Daniel Siconolfi

    Introduction Tobacco and marijuana co-use among young people in the U.S. is a public health concern that deserves greater attention. This study addresses a significant gap in the literature by examining the prevalence and correlates of tobacco and marijuana co-use among young people experiencing homelessness. Methods The analytic sample consisted of 449 unaccompanied homeless youth (mean age = 22; 72% male) who had used any type of tobacco product in the past 30 days. Participants were recruited from 12 service sites and 13 street sites in Los Angeles County. Results Over 90% of young homeless tobacco users reported past month marijuana and tobacco co-use: 65% reported any co-administration (mixing both substances in a cigarette, joint, blunt, bong, hookah, pipe or bowl) and 27% reported only using them separately. Analysis of covariance tests found that co-administrators reported greater quantity and frequency of tobacco cigarette use, more frequent marijuana use, and, in some cases, poorer functioning and more severe homelessness compared to other tobacco users (p < .05). Logistic regression analysis indicated that co-administration was less likely among youth who were Black (vs. white) and who perceived it as being the same or more harmful than cigarette smoking, but more likely among youth who reported greater exposure to peers who engaged in co-administration (p < .05). Conclusions Co-administration of tobacco and marijuana is prevalent among young tobacco users experiencing homelessness. Results add to a growing literature on the prevalence and potential risks of co-administration among young people that can inform policies aimed at regulating tobacco and marijuana products.

    更新日期:2019-12-13
  • Psychiatric Comorbidities in a Comparative Effectiveness Smoking Cessation Trial: Relations with Cessation Success, Treatment Response, and Relapse Risk Factors
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-12
    Adrienne L. Johnson; Jesse Kaye; Timothy B. Baker; Michael C. Fiore; Jessica W. Cook; Megan E. Piper

    BACKGROUND Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5% Female, 68.1% white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.

    更新日期:2019-12-13
  • Determinants of selection into buprenorphine/naloxone among people initiating opioid agonist treatment in British Columbia
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-11
    F. Homayra, N. Hongdilokkul, M. Piske, L.A. Pearce, C. Zhou, J.E. Min, E. Krebs, B. Nosyk

    Background Studies assessing the comparative effectiveness of methadone versus buprenorphine/naloxone for opioid use disorder in real-world settings are rare - challenged by structural differences in delivery across settings and factors influencing treatment selection. We identified determinants of selection into buprenorphine/naloxone and quantified contributions of individual and provider-level covariates in a setting delivering both medications within the same healthcare settings. Methods Utilizing linked health administrative datasets, we conducted a retrospective cohort study of people with opioid use disorder (PWOUD) receiving opioid agonist treatment (OAT) in British Columbia, Canada, from 2008-2017. Determinants of buprenorphine/naloxone selection were identified using a generalized linear mixed model with random intercept terms for providers and individuals. We determined the influence of individual demographics, clinical history, measures of provider experience and preference, and dates of key policy changes. Results A total of 39,605 individuals experienced 178,976 OAT episodes (methadone:139,439(77.9%);buprenorphine/naloxone:39,537(22.1%)). Male sex, less OAT experience, younger age, mental health conditions and chronic pain were associated with higher odds of buprenorphine/naloxone prescription. For providers, higher client-attachment, more complex OAT case-mixes, and higher buprenorphine/naloxone prescribing-preference were also associated with higher odds of buprenorphine/naloxone prescription. Observed individual-level covariates explained 9.7% of variance in odds of buprenorphine/naloxone selection, while observed provider-level covariates explained 20.0%. Controlling for covariates, residual unmeasured between-individual variance accounted for 18.5% of the explained variation in the odds of buprenorphine/naloxone selection, while unmeasured between-provider variance accounted for 28.4%. Conclusion Provider characteristics were more influential in selection of buprenorphine/naloxone over methadone informing subsequent analyses of comparative effectiveness of these regimens.

    更新日期:2019-12-11
  • Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-11
    Craig A. Field, Kirk Von Sternberg, Mary M. Velasquez

    Background The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs. Method Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome. Results A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use. Conclusions The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.

    更新日期:2019-12-11
  • Impact of a jail-based treatment decision-making intervention on post-release initiation of medications for opioid use disorder
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-11
    C.J Banta-Green, J. Williams, J.M. Sears, A.S. Floyd, J. Tsui, T. Hoeft

    Introduction Opioid use disorder (OUD) is common among people in jail and is effectively treated with medications for OUD (MOUD). People with OUD may have an incomplete or inaccurate understanding of OUD and MOUD, and of how to access care. We evaluated an OUD treatment decision making (TDM) intervention to determine whether the intervention increased MOUD initiation post-release. Methods We conducted an observational retrospective cohort study of the TDM intervention on initiation of MOUD, individuals with records data indicating confirmed or suspected OUD incarcerated in four eligible jails were eligible to receive the intervention. Time-to-event analyses of the TDM intervention were conducted using Cox proportional hazard modeling with MOUD as the outcome. Results Cox proportional hazard modeling, with the intervention modeled as having a time-varying effect due to violation of the proportionality assumption, indicated that those receiving the TDM intervention (n = 568) were significantly more likely to initiate MOUD during the first month after release from jail (adjusted hazard ratio 6.27, 95% C.I. 4.20-9.37), but not in subsequent months (AHR 1.33 95% C.I. 0.94-1.89), adjusting for demographics, prior MOUD, or felony or gross misdemeanor arrest in the prior year compared to those not receiving the intervention (n = 3,174). Conclusion The TDM intervention was associated with a significantly higher relative hazard of starting MOUD, specifically during the first month after incarceration. However, a minority of all eligible people received any MOUD. Future research should examine ways to increase initiation on MOUD immediately after (or ideally during) incarceration.

    更新日期:2019-12-11
  • New approach in the measurement of long-term alcohol consumption trends: Application of wastewater-based epidemiology in an Australian regional city
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-11
    Qiuda Zheng, Benjamin J. Tscharke, Catharina Krapp, Jake W. O’Brien, Rachel S. Mackie, Jason Connor, Jochen F. Mueller, Kevin V. Thomas, Phong K. Thai

    Background Wastewater-based epidemiology (WBE) provides complementary information to traditional self-report methods for estimating substance use within a population. WBE was applied to estimate the consumption of alcohol in an Australian rural city (population estimated 100,000) over 6 years. Methods A total of 352 wastewater samples were analysed from a wastewater treatment plant located in South-East Queensland, Australia, from 2012 to 2017. The concentration of an alcohol biomarker, ethyl sulphate, was quantified by liquid chromatography tandem mass spectrometry and used to estimate per-capita consumption. The WBE results were compared with alcohol consumption estimates based on national taxation data and self-reported national survey data in Australia. Results Average daily alcohol consumption estimated by WBE was between 19 and 30 mL/person/day for the population aged 15 years and older during the six-year period. Alcohol consumption decreased 4% per annum on average over the study period. Our data showed higher rates of consumption on weekends and public holidays when compared to consumption between Monday and Thursday. The comparative trend of WBE data was consistent with the national alcohol survey and taxation statistics on alcoholic beverages over the same period. Conclusions A clear decline in alcohol consumption in the catchment was observed during the sampling period, which reflected similar changes in consumption from taxation statistics and self-report survey data. Expected variations in weekly consumption and public holidays were also identified. This study demonstrates the potential of WBE for long-term monitoring of alcohol consumption in evaluating the effectiveness of local and national alcohol policies and prevention programs.

    更新日期:2019-12-11
  • Prescription Opioid Misuse among Heterosexual versus Lesbian, Gay, and Bisexual Military Veterans: Evidence from the 2015-2017 National Survey of Drug Use and Health
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-10
    Kaston D. Anderson-Carpenter, Jaleah D. Rutledge, Koi Mitchell

    Background Little research examines risks of opioid misuse among military veterans, particularly among minority military veterans. The present study examines lifetime and past 12-month prescription opioid misuse among heterosexual versus non-heterosexual military veterans in the United States. Method Participants comprised 9,729 U.S. military veterans aged 18 and older who completed the 2015-2017 National Survey on Drug Use and Health (NSDUH). Sample weights were applied to yield nationally representative estimates in the target population. Design-based multivariable logistic regression analysis was used to examine associations between sociodemographic characteristics and risk of prescription opioid misuse. Results Bisexual veterans reported greater lifetime odds of having misused prescription opioids in their lives compared to their heterosexual peers (AOR: 4.04, 95% CI: 1.72-5.38). However, only bisexual women veterans reported elevated risk past 12-month misuse (AOR: 3.47, 95% CI: 1.28, 9.41). Although veterans aged 50 and older reported lower risk of lifetime prescription opioid misuse relative to 18-34 year olds (AOR: 0.33, 95% CI: 0.25-0.44), older veterans showed greater risk of past 12-month misuse (AOR: 1.23, 95% CI: 1.02-1.49) Discussion To our knowledge, this study is the first to systematically examine differential risk factors of prescription opioid misuse between heterosexual and non-heterosexual military veterans. Results from this study suggest a critical need for greater investigations into the specific risks of opioid-related substance use for military veterans. This study highlights areas of research and practice that can improve health outcomes for military veterans and their communities.

    更新日期:2019-12-11
  • Impact of Electronic Nicotine Delivery Systems and Other Respondent Characteristics on Tobacco Use Transitions among a U.S. National Sample of Women of Reproductive Age
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-10
    Allison N. Kurti, Janice Y. Bunn, Katherine Tang, Tyler Nighbor, Diann E. Gaalema, Victoria Coleman-Cowger, Sulamunn R.M. Coleman, Stephen T. Higgins

    Background Identifying predictors of tobacco use patterns that differ in harm among reproductive-aged women may inform efforts to protect women and children against adverse health impacts of tobacco use. Methods Changes in tobacco use patterns were examined among women (18-49 years) who completed Wave 1 (W1) and Wave 2 (W2), or W2 and Wave 3 (W3) of the U.S. Population Assessment of Tobacco and Health (PATH, 2013-2016) study, and were using cigarettes, filtered cigars and/or cigarillos in the first wave over which data were included for that respondent (Time 1; T1). We examined the proportion of respondents whose tobacco use transitions from T1 to Time 2 (T2) were harm-maintaining (continued using combusted tobacco), harm-reducing (transitioned to electronic nicotine delivery systems (ENDS), or harm-eliminating (quit tobacco). Multinomial logistic regressions (with harm-maintaining as the baseline category) were conducted to examine associations between ENDS use, demographic, and psychosocial characteristics with each transition. Results A majority of women (83%) exhibited harm-maintaining transitions, followed by harm-eliminating (14.7%) and harm-reducing (2.3%) transitions. Use of ENDS at T1 was associated with increased odds of harm reduction and decreased odds of harm elimination. Younger women were more likely to make both harm-reducing and harm-eliminating transitions. Increased educational attainment, identifying as Black or Hispanic, increased psychiatric symptoms, and pregnancy were associated with harm elimination, whereas living at or above poverty was associated with harm reduction. Conclusions Study results contribute new information on the impact of ENDS, sociodemographic characteristics, psychiatric symptoms, and pregnancy on tobacco use transitions among reproductive-aged women.

    更新日期:2019-12-11
  • Depression, post-traumatic stress disorder, suicidality and self-harm among people who inject drugs: a systematic review and meta-analysis
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-12-10
    Samantha Colledge, Sarah Larney, Amy Peacock, Janni Leung, Matt Hickman, Jason Grebely, Michael Farrell, Louisa Degenhardt

    Background A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID. Methods We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm. Findings We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0% (95% confidence interval [CI] = 21.3, 62.8%), and for a depression diagnosis was 28.7% (95% CI = 20.8, 36.6%). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1% (95% CI = 19.3, 24.9%). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID. Interpretation Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.

    更新日期:2019-12-11
  • Discrimination Learning in Oxycodone-Treated Nonhuman Primates
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-27
    Sarah L. Withey, Rachel J. Doyle, Erica N. Porter, Jack Bergman, Brian D. Kangas

    Background Prescription opioid abuse continues to be a public health concern of epidemic proportions. Notwithstanding the extensive literature regarding opioid action, there has been little systematic research regarding the effects of opioid dependence and withdrawal on aspects of cognition-related behavior in laboratory animals. The present studies examined the effects of the prescription opioid oxycodone on learning processes in nonhuman primates. Methods The ability of subjects to repeatedly learn novel touchscreen-based visual discriminations was examined during three conditions of opioid exposure. Discrimination learning was examined, first, during oxycodone self-administration (3-hr sessions, 0.1 mg/kg/infusion) and, next, during non-contingent chronic treatment with oxycodone (10 mg/kg/day). Finally, discrimination learning was re-examined during antagonist-precipitated opioid withdrawal (0.001-0.1 mg/kg naltrexone) and, subsequently, following abrupt discontinuation of oxycodone treatment. Results Although motoric behavior was disrupted by oxycodone, neither the development of discrimination learning nor steady-state performance were impaired following oxycodone self-administration or during non-contingent chronic oxycodone treatment. However, discrimination learning was substantially impaired during oxycodone withdrawal, whether elicited by naltrexone or by abrupt oxycodone discontinuation. Moreover, these learning impairments were concordant with autonomic signs of opioid withdrawal. Conclusions Taken together, the present studies indicate that impairment of learning processes can accompany the unconditioned signs of opioid withdrawal.

    更新日期:2019-11-28
  • Depressive Symptoms and Substance Use: Changes Overtime among a Cohort of HIV-positive and HIV-negative MSM
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-27
    Marjan Javanbakht, Steven Shoptaw, Amy Ragsdale, Ron Brookmeyer, Robert Bolan, Pamina M. Gorbach

    Background The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. Methods Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. Results The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). Conclusions The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.

    更新日期:2019-11-27
  • Alcohol And Disgust: An Intimate Relationship
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-26
    Lorenzo D. Stafford, Alistair Sekulla, Ed Morrison, Diana S. Fleischman, Alistair J. Harvey

    Background Alcohol intoxication has been associated with increases in risk taking behavior and more ambiguously, alterations in emotional perception. In the first study of its kind, we examine how theories of disgust can be used to help explain these effects. Methods Using a single-blind procedure, participants (n = 73) were randomly allocated to an alcohol (Males: 0.68 g/kg; Females: 0.60 g/kg) or placebo condition and then completed a psychometric measure of disgust (TDDS). Results Results revealed a non-significant trend toward lower disgust sensitivity in the alcohol versus placebo condition. We did however find a significant negative correlation, whereby increases in breath alcohol level were associated with decreased pathogen disgust. Conclusions These findings demonstrate a relationship between breath alcohol level and disgust sensitivity which could help explain differences in risk associated behavior.

    更新日期:2019-11-27
  • Ibudilast attenuates peripheral inflammatory effects of methamphetamine in patients with methamphetamine use disorder
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-26
    Michael J. Li, Marisa S. Briones, Keith G. Heinzerling, Mariah Kalmin, Steven J. Shoptaw

    Background Preclinical studies suggest that the non-selective phosphodiesterase inhibitor, Ibudilast (IBUD) may contribute to the treatment of METH use disorder through the attenuation of METH-induced inflammatory markers such as adhesion molecules, sICAM-1 and sVCAM-1, and cytokines, IL-6 and TNF-α. Objective The present study aimed to test whether treatment with IBUD can attenuate peripheral markers of inflammation during a METH challenge in an inpatient clinical trial of 11 patients. Methods This trial followed a randomized, within-subjects crossover design where participants received a METH challenge, during which five participants were treated with placebo then with IBUD, while the remaining six participants were treated with IBUD prior to placebo. Mixed effects regression modeled changes in peripheral markers of inflammation—sICAM-1, sVCAM-1, TNF-α, IL-6, MIF, and cathepsin D—by treatment condition, with measurements at baseline, 60 minutes post-METH infusion, and 360 minutes post-METH infusion. Results: While on placebo, sICAM-1, sVCAM-1, and cathepsin D significantly increased by 60 minutes post-METH infusion, while IL-6 significantly increased 360 minutes post-METH infusion. Treatment with IBUD significantly reduced METH-induced levels of sICAM-1, sVCAM-1, and cathepsin D at 60 minutes post-METH infusion. Conclusions Our findings demonstrate that IBUD attenuated acute pro-inflammatory effects of METH administration, which may have implications for treatment of METH use disorder.

    更新日期:2019-11-27
  • Building the Community: Endogenous Network Formation, Homophily and Prosocial Sorting Among Therapeutic Community Residents
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-26
    Keith Warren, Benjamin Campbell, Skyler Cranmer, George De Leon, Nathan Doogan, Mackenzie Weiler, Fiona Doherty

    Background Researchers have begun to consider the ways in which social networks influence therapeutic community (TC) treatment outcomes. However, there are few studies of the way in which the social networks of TC residents develop over the course of treatment. Methodology We used a Temporal Exponential Random Graph Model (TERGM) to analyze changes in social networks totaling 320,387 peer affirmations exchanged between residents in three correctional TCs, one of which serves men and two of which serve both men and women. The networks were analyzed within weekly and monthly time-frames. Results Within a weekly time-frame residents tended to close triads. Residents who were not previously connected tended not to affirm the same peers. Residents showed homophily by entry cohort. Other results were inconsistent across TC units. Within a monthly time-frame participants showed homophily by graduation status. They showed the same patterns of triadic closure when connected, tendency not to affirm the same peers when not connected and homophily by cohort entry time as in a weekly time frame. Conclusions TCs leverage three human tendencies to bring about change. The first is the tendency of cooperators to work together, in this case in seeking graduation. The second is the tendency of people to build clusters. The third is homophily, in this case by cohort entry time. Consistent with TC clinical theory, residents spread affirmations to a variety of peers when they have no previous connection. This suggests that residents balance network clustering with a concern for the community as a whole.

    更新日期:2019-11-27
  • Nonhuman Animal Models of Substance Use Disorders: Translational Value and Utility to Basic Science
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-21
    Mark A. Smith

    Background The National Institute on Drug Abuse (NIDA) recently released a Request for Information (RFI) soliciting comments on nonhuman animal models of substance use disorders (SUD). Methods A literature review was performed to address the four topics outlined in the RFI and one topic inspired by the RFI: (1) animal models that best recapitulate SUD, (2) animal models that best balance the trade-offs between resources and ecological validity, (3) animal models whose translational value are frequently misrepresented or overrepresented by the scientific community, (4) aspects of SUD that are not currently being modeled in animals, and (5) animal models that are optimal for examining the basic mechanisms by which drugs produce their abuse-related effects. Results Models that employ response-contingent drug administration, use complex schedules of reinforcement, measure behaviors that mimic the distinguishing features of SUD, and use animals that are phylogenetically similar to humans have the greatest translational value. Models that produce stable and reproducible baselines of behavior, lessen the number of uncontrolled variables, and minimize the influence of extraneous factors are best at examining basic mechanisms contributing to drug reward and reinforcement. Conclusions Nonhuman animal models of SUD have undergone significant refinements to increase their utility for basic science and translational value for SUD. The existing literature describes numerous examples of how these models may best be utilized to answer mechanistic questions of drug reward and identify potential therapeutic interventions for SUD. Progress in the field could be accelerated by further collaborations between researchers using animals versus humans.

    更新日期:2019-11-22
  • Sexual minority substance use disparities: Bisexual women at evaluated risk relative to other sexual minority groups
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-21
    Megan S. Schuler, Rebecca L. Collins

    Background Prior studies characterizing sexual minority substance use disparities have primarily compared lesbian/gay and bisexual individuals, respectively or in combination, to heterosexual individuals. In light of emerging evidence that bisexual individuals may have particularly elevated substance use risk, we examine differences in recent substance use between bisexual and lesbian/gay individuals using national survey data. Methods Data on 126,463 adults (including 8,241 LGB adults) were from the 2015-2017 National Survey on Drug Use and Health. Substance use outcomes included binge drinking, cigarette smoking, cigar smoking, marijuana use, illicit drug use, opioid misuse, alcohol use disorder, nicotine dependence, and substance use disorder. Logistic regression was used to estimate sexual identity- and gender-specific odds ratios, controlling for demographic characteristics. Of particular interest were estimates comparing bisexual and lesbian/gay individuals of the same gender. Results Both male and female sexual minority adults had significantly elevated rates of substance use compared to heterosexual adults. Furthermore, relative to lesbian/gay women, bisexual women had significantly elevated odds of binge drinking (aOR = 1.29), marijuana use (aOR = 1.42), illicit drug use (aOR = 1.55), opioid misuse (aOR = 1.53) and alcohol use disorder (aOR = 1.48). Relative to gay men, bisexual men had significantly elevated cigar use (aOR = 1.64). Conclusions Bisexual women were at significantly greater risk for multiple substance use behaviors relative to lesbian/gay women. We did not observe any substance use behaviors for which bisexual individuals had significantly lower risk than their lesbian/gay peers. These disparities may be explained, in part, by unique risk factors for substance use experienced by bisexual individuals, particularly bisexual women.

    更新日期:2019-11-22
  • The Association between Pain Clinic Laws and Prescription Opioid Exposures: New Evidence from Multi-state Comparisons
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-21
    Di Liang, Yuyan Shi

    Objectives States in the US are controlling opioid prescribing to combat the opioid epidemic. Prescription Drug Monitoring Programs (PDMPs) were widely adopted, whereas less attention was given to pain clinic laws. This study examined the associations of mandatory use of PDMPs and pain clinic laws with prescription opioid exposures. Methods State-level quarterly prescription opioid exposures reported to the National Poison Data System during 2010-2017 were analyzed. The primary outcome was age-adjusted rates of prescription opioid exposures per 1,000,000 population. The primary policy variables included the implementation of mandatory use of PDMPs alone, the implementation of pain clinic laws alone, and the implementation of both mandatory use of PDMPs and pain clinic laws. Linear regressions were used to examine the associations, controlling for other opioid policies, marijuana policies, socioeconomic factors, state fixed effects, time fixed effects, and state-specific time trends. Results Requiring mandatory use of PDMPs alone was not associated with significant changes in prescription opioid exposures. The implementation of pain clinic laws with or without concurrent mandatory use of PDMPs was associated with 5 fewer prescription opioid exposures per 1,000,000 population or a 9% reduction compared to the pre-policy period (p < 0.01). Further analysis revealed that the reduction associated with pain clinic laws was pronounced in exposures reported by healthcare facilities. Conclusions This multi-state study provided new evidence that the implementation of pain clinic laws was associated with a significant reduction in prescription opioid exposures. Pain clinic laws may deserve further evaluation and consideration.

    更新日期:2019-11-22
  • Cocaine-related alterations in fronto-parietal gray matter volume correlate with trait and behavioral impulsivity
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-20
    Christina S. Meade, Ryan P. Bell, Sheri L. Towe, Shana A. Hall

    Background Chronic cocaine use is associated with structural brain abnormalities within prefrontal regions implicated in impulsivity. Despite high levels of impulsivity among persons who use cocaine, it is not known how reductions in gray matter volume (GMV) may relate to trait and behavioral measures of impulsivity. Methods The sample included 39 active cocaine users (COC+) and 40 controls with no history of cocaine use (COC-). Participants had a brain scan on a 3 T MRI machine and completed out-of-scanner measures of trait impulsivity and delayed reward discounting. Whole-brain voxel-based morphometry was used to compare GMV between COC + and COC-. Within regions that differed between groups, voxelwise correlations were conducted to examine the relationship between GMV and impulsivity. Results In a whole-brain analysis, COC + had broad reductions in GMV compared to COC- in bilateral frontal, parietal, occipital, and cerebellar regions. Lower GMV correlated with trait impulsivity in lateral prefrontal regions and with delayed reward discounting in medial prefrontal regions, while lower GMV correlated with both measures in the posterior parietal cortex. COC + demonstrated significantly higher impulsivity than COC- on all measures, but the nature of the correlation with GMV was similar in both groups. Conclusions Reflecting the multi-faceted nature of impulsivity, these results show that trait and behavioral measures of impulsivity map differentially onto altered brain morphology. While the brain-behavior patterns were similar in COC + and COC-, suggesting that impulsivity varies on a continuous spectrum, cocaine-related abnormalities in frontal-parietal brain systems may contribute to heightened impulsivity.

    更新日期:2019-11-21
  • Is Cannabis Use Associated with Tobacco Cessation Outcome? An Observational Cohort Study in Primary Care
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-20
    Sabrina Voci, Laurie Zawertailo, Dolly Baliunas, Zara Masood, Peter Selby

    Background Some studies suggest cannabis use negatively affects tobacco cessation outcomes, but findings have been mixed. We examined whether cannabis use was associated with tobacco cessation outcomes in a real-world primary care setting. Methods The analytic dataset consisted of 35,246 patients who enrolled between 2014 and 2016 in a primary care-based smoking cessation program in Ontario, Canada. Past 30-day cannabis use, for recreational or medical purposes, was self-reported at enrollment. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. Results Thirty days prior to enrollment, 79.9% of patients had not used cannabis, 16.3% used cannabis for recreational purposes only, and 3.8% used cannabis for medical purposes. Unadjusted and adjusted odds of tobacco cessation at 6 months were reduced for patients using cannabis compared to non-users (ORs = 0.76-0.86, ps<0.05). When cannabis use was categorized by purpose, both unadjusted and adjusted odds of cessation were significantly lower for recreational users (ORs = 0.77-0.84, ps<0.05). Medical users had decreased odds of cessation in unadjusted analysis (OR = 0.74, 95% CI = 0.61-0.89, p = 0.001), but not after adjustment for potential confounders. However, post-estimation contrasts did not indicate a significant difference between the effect of recreational and medical cannabis use. Conclusions In a large real-world sample of patients seeking smoking cessation treatment, concurrent cannabis use was associated with decreased success with quitting smoking. Recreational cannabis use was consistently related to poorer cessation outcomes, but medical use was not. Additional research is needed to inform treatment strategies for this growing sub-population of smokers.

    更新日期:2019-11-21
  • Patterns of alcohol use and associated characteristics and HIV-related outcomes among a sample of African-American women living with HIV
    Drug Alcohol Depen. (IF 3.466) Pub Date : 2019-11-20
    Lauren Lipira, Deepa Rao, Paul E. Nevin, Christopher G. Kemp, Susan E. Cohn, Janet M. Turan, Jane M. Simoni, Michele P. Andrasik, Audrey L. French, Joseph M. Unger, Patrick Heagerty, Emily C. Williams

    Background Alcohol use is common among people living with HIV and negatively impacts care and outcomes. African-American women living with HIV are subject to vulnerabilities that may increase risk for alcohol use and associated HIV-related outcomes. Methods We used baseline data from a randomized controlled trial of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago and Birmingham (2013-2015). Patterns of alcohol use [any use, unhealthy alcohol use (UAU), heavy episodic drinking (HED)] were measured using the AUDIT-C. We assessed demographic, social, and clinical characteristics which may influence alcohol use and HIV-related outcomes which may be influenced by patterns of alcohol use in bivariate and multivariable analyses. Results Among 220 African-American women living with HIV, 54% reported any alcohol use, 24% reported UAU, and 27% reported HED. In bivariate analysis, greater depressive symptoms, low religiosity, low social support, marijuana, and crack/cocaine use were associated with patterns of alcohol use (p < 0.05). Marijuana and cocaine/crack use were associated with patterns of alcohol use in adjusted analysis (p < 0.05). In adjusted analysis, any alcohol use and HED were associated with lower likelihood of ART adherence (ARR = 0.72, 95% CI: 0.53-0.97 and ARR = 0.65, 95% CI: 0.44-0.96, respectively), and UAU was associated with lack of viral suppression (ARR = 0.78, 95% CI: 0.63-0.96). Conclusions Findings suggest any and unhealthy alcohol use is common and associated with poor HIV-related outcomes in this population. Regular alcohol screening and intervention should be offered, potentially targeted to subgroups (e.g., those with other substance use).

    更新日期:2019-11-21
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